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Review
. 2014 Sep 6:1:40-8.
doi: 10.1016/j.ejro.2014.07.001. eCollection 2014.

Current update on combined hepatocellular-cholangiocarcinoma

Suresh Maximin  1 , Dhakshina Moorthy Ganeshan  2 , Alampady K Shanbhogue  3 , Manjiri K Dighe  1 , Matthew M Yeh  4 , Orpheus Kolokythas  5 , Puneet Bhargava  6 , Neeraj Lalwani  1
Affiliations
Review

Current update on combined hepatocellular-cholangiocarcinoma

Suresh Maximin et al. Eur J Radiol Open. .

Abstract

Combined hepatocellular-cholangiocarcinoma is a rare but unique primary hepatic tumor with characteristic histology and tumor biology. Recent development in genetics and molecular biology support the fact that combined hepatocellular-cholangiocarcinoma is closely linked with cholangiocarcinoma, rather than hepatocellular carcinoma. Combined hepatocellular cholangiocarcinoma tends to present with an more aggressive behavior and a poorer prognosis than either hepatocellular carcinoma or cholangiocarcinoma. An accurate preoperative diagnosis and aggressive treatment planning can play crucial roles in appropriate patient management.

Keywords: Cholangiocarcinoma; Cirrhosis; Computed tomography; Hepatocellular carcinoma; Magnetic resonance imaging.

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Figures

Fig. 1
Fig. 1
59-Year-old man with chronic hepatitis B. (a) Axial CT (arterial phase): hypodense mass is seen in the right hepatic lobe (circle). Note incidental cholelithiasis. (b) Venous phase: foci of peripheral enhancement in the hypodense mass (arrow). (c) Equilibrium phase: the mass demonstrates central enhancement in the delayed phase (asterisk) surrounded by hypodense rim (large arrow). Washout is evident in the previously seen peripheral enhancing foci (small arrow). (d and e) H&E stain images at 4× and 10× magnifications showing malignant cells of hepatocellular carcinoma (figure d, asterisk) seen alongside malignant cells of cholangiocarcinoma (figure d, box). The diagnosis was consistent with CC dominant cHCC-CC.
Fig. 2
Fig. 2
42-Year-old-Vietnamese woman with history of hepatitis. (a) Axial T1w in-phase image shows hypointense mass in right hepatic lobe (arrow). (b) Axial T1w opposed-phase image shows no signal drop, which rules out presence of (microscopic) fat (therefore adenoma or well differentiated HCC). (c) Axial T2w image shows peripheral rind of intermediate signal intensity (arrow) with central hypointensity (asterisk). Scattered foci of hyperintensity centrally (small arrow). (d) Arterial phase shows peripheral enhancement of the mass (arrow) with minimally enhancing central component (asterisk). (e) Venous phase demonstrates washout in the periphery (arrow) and progressively enhancing central component which corresponds to fibrosis within the CC component at subsequent histopathology (asterisk). (f) Equilibrium phase shows persistent central enhancement (asterisk). (g) H&E stain images at 4× magnifications showing mixed components. (h) CD10 antibody staining protocol for immunohistochemistry. (i) Glypican-3 staining highlighting the HCC component.
Fig. 3
Fig. 3
Algorithmic approach to elevated tumor markers and enhancement pattern on imaging.
Fig. 4
Fig. 4
Making pre-operative diagnosis of cHCC-CC.
See this image and copyright information in PMC

References

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